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ChikV warning from Carpha: Clean up health centres too

Health care providers in the Caribbean are being warned that they could be at increased risk for contracting the Chikungunya virus (ChikV) from mosquitoes breeding at health institutions. “We are having a situation in some islands where health care providers, including doctors and nurses, are themselves coming down with the illness,” said Dr Karen Polson-Edwards, senior technical officer of Vector-borne Diseases and Neglected Tropical Diseases at the Caribbean Public Health Agency (Carpha), in a telephone interview yesterday. The reason for that trend, she said, was that mosquito breeding grounds were allowed to thrive in and around hospitals and health centres.

In calling on hospital managers and health authorities to ensure that the surroundings of all health facilities were cleaned, she said: “Even though we are telling people to clean up their surroundings, we have to ensure that the health facilities themselves are not contributing to the problem by allowing mosquitoes to breed in and around where patients are waiting to be seen.
“In a situation like that, the patient is right there, the mosquito is there and you can have the virus being transmitted... and the areas become amplifiers for the virus.”

Although most cases of ChikV in the Caribbean did not lead to hospitalisation, she added, patients usually visited primary health care facilities, like health centres and GP clinics, to be seen, so measures must be put in place to ensure that all these facilities are up to mark, she added. In a telephone interview, Dr Shehenaz Mohammed, chairman of the North-Central Regional Health Authority, said the authority had been working in the last year to clean health facilities in the region. She added managers of facilities have been advised to pay attention to the surroundings during the crucial period and the NCRHA had procured additional bed nets to prepare for an expected increase in ChikV cases in hospitals. The first locally-acquired cases of ChikV were reported on Wednesday in a 70-year-old woman from Diego Martin and a 15-year-old boy from Arima, bringing the total number of confirmed cases of ChikV in T&T to five.

ChikV vs dengue
ChikV and dengue are transmitted by the same mosquito, the aedes aegypti but Polson-Edwards said there were key differences between the diseases. “ChikV has what we call a high attack rate which seems to be higher than that of dengue. This explains the rapid spread,” she said. The attack rate is the frequency of infection or the rate of spread.

ChikV’s high attack rate, she said, was noted when an estimated 500,000 cases of ChikV were reported between 2004 and 2006 in Kenya and islands in the Indian Ocean. “You can appreciate the effect it will have on a population if such a large portion comes down with the illness,” she said. Although it had a lower attack rate than ChikV, dengue was the more serious, she said.

She added: “Dengue has four different types so you can actually get dengue four times. “For some people, the more they get dengue the more likely it is to get severe dengue, which involves haemorrhaging, and if they are not attended to immediately then they can go into shock and die. So people can actually die from dengue. “With ChikV, the mortality rate is not as high.” She said most deaths associated with ChikV were caused by pre-existing conditions. But she warned the impact of ChikV in the region should not be underestimated.

“The initial symptoms are debilitating. From what has been observed in the region, we saw persons with the virus who could have hardly walked because it’s so painful and some could not use their hands,” she added. Saying the spread of the virus in the Caribbean was still at an early stage, she said: “In other outbreaks, persons have gotten the chronic form of the disease, so months and years after they still have these joint pains but we haven’t seen this type in the region so far.”